Overpayment Recovery Specialist - Claims & Refunds

CVS Health; Phoenix (AZ); Presencial; USD 25 000 - 53 000; Tempo integral

Resumo da oferta

CVS Health in Phoenix, AZ is seeking an experienced Overpayment Recovery Specialist to review and resolve overpayment items, coordinate with vendors, and ensure compliance. You will engage with members, providers, and insurers to secure recoveries and allocate refunds.

This full-time role demands 3+ years of medical claims processing and the ability to manage multiple tasks in a fast-paced setting. The position offers a competitive hourly pay range, benefits, and opportunities to contribute to

Qualificações

• 3+ years of medical claims processing experience.
• 2+ years of claims adjustments/rework.
• 2+ years in a fast-paced, deadline-driven environment.
• Experience conducting outbound provider outreach calls.
• Experience handling customer service inquiries by phone and/or written correspondence.
• Ability to interpret and apply eligibility, coverage and benefits guidelines.
• Demonstrated ability to manage multiple assignments with accuracy.

Responsabilidades

• Review and resolve overpayment recovery items via phone and written correspondence with limited supervision.
• Partner with internal units, vendors, and liaisons to recover funds and allocate refunds.
• Administer overpayment policies and procedures with members, providers and insurers.
• Manage overpayment work inventory and follow up to achieve recovery goals.
• Coordinate escalated overpayments with key business functions.
• Use analysis to solve complex, non-routine recovery issues.
• Use reporting to track inventory, productivity and recovery results.
• Perform claim adjustments and rework calculations across dollar amounts.
• Apply medical necessity guidelines and verify eligibility for adjudication.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments and refunds.
• Deliver recovery training for less experienced team members.
• Handle customer service inquiries and issues.

Conhecimentos

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service

Guideline interpretation

Attention to detail

Formação académica

Associate degree

Descrição da oferta de emprego

CVS Health in Phoenix, AZ is seeking an experienced Overpayment Recovery Specialist to review and resolve overpayment items, coordinate with vendors, and ensure compliance. You will engage with members, providers, and insurers to secure recoveries and allocate refunds.

This full-time role demands 3+ years of medical claims processing and the ability to manage multiple tasks in a fast-paced setting. The position offers a competitive hourly pay range, benefits, and opportunities to contribute to